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Obsessive-compulsive and related disorders

It is common for young people to have some preoccupations and repetitive behaviours. However, obsessive-compulsive and related disorders involve obsessions, compulsions, preoccupations or body-related repetitive behaviours that are excessive, cause distress and impact young people’s daily lives.

Obsessions are unwanted, intrusive, repetitive and persistent thoughts, urges or images that cause young people to feel distressed or anxious.

Compulsions are repetitive behaviours or mental acts that young people feel compelled to perform in response to having an obsessive thought, urge or image. They perform the compulsions in an attempt to prevent or neutralise the obsession or to prevent or reduce the anxiety and distress caused by the obsession.

Preoccupations are when a young person is absorbed or engrossed with something. In the case of body dysmorphic disorder, they are preoccupied with perceived flaws in their appearance and carry out body-related repetitive behaviours to reduce the distress that is caused by their preoccupations.

Body-related repetitive behaviours are behaviours that young people perform repeatedly that involve their bodies, such as: (in trichotillomania disorder) repeatedly pulling out their hair, (in excoriation disorder) repeatedly picking at their skin or (in body dysmorphic disorder) repeatedly checking themselves in the mirror, excessively grooming themselves, picking at their skin or seeking reassurance from others about their appearance.

Find more information below about the types of obsessive-compulsive and related disorders, how we determine if your child has an obsessive-compulsive or related disorder and how we treat your child with an obsessive-compulsive and related disorder. If you believe your child might have an obsessive-compulsive or related disorder and you would like us to help, please contact us to schedule an appointment.

Types of disorders

Obsessive-compulsive disorder

Young people with obsessive-compulsive disorder have obsessions and/or compulsions that are time-consuming, cause great distress and impact their daily lives. Obsessions are unwanted, intrusive, repetitive and persistent thoughts, urges or images that cause young people to feel very distressed or anxious. Young people often try to ignore, suppress or neutralise these obsessions by performing rituals known as compulsions. Compulsions are repetitive behaviours or mental acts that young people feel compelled to perform in response to having an obsessive thought, urge or image. The specific content of the obsessions and compulsions varies by individual, but the obsessions commonly involve: cleaning (obsessions: being worried about contamination; compulsions: washing and cleaning), symmetry (obsessions: being concerned about symmetry; compulsions: repeating, ordering and counting), forbidden/taboo thoughts (aggressive, sexual or religious obsessions and compulsions) and harm (obsessions: fear of hurting themselves or others; compulsions: checking). Young people experience great distress as a result of their obsessions and compulsions which often negatively impact their social activities/relationships, schooling and/or recreational activities.

Obsessive-compulsive disorder usually starts in adolescence. Boys are more likely than girls to experience obsessive-compulsive disorder during childhood (before ten years of age). Young people who have dysfunctional beliefs (e.g., having an inflated sense of responsibility, being perfectionistic, being intolerant of uncertainty, overestimating threats and feeling the need to control thoughts), or who have parents with obsessive-compulsive disorder, are at a greater risk of developing obsessive-compulsive disorder. Young people with obsessive-compulsive disorder are more likely than young people without the disorder to have the following related disorders: body dysmorphic disorder, trichotillomania disorder and excoriation disorder. Young people with obsessive-compulsive disorder also commonly experience other mental health concerns, such as tic disorders, anxiety disorders and depression. Alarmingly, 50% of young people with obsessive-compulsive disorder have suicidal thoughts and 25% have made suicide attempts.

Because obsessive-compulsive disorder can reduce young people’s quality of life, be long lasting without intervention, and occur in combination with other mental health concerns, it is very important to seek early treatment and support.

Body dysmorphic disorder

It is common for young people to think about their appearance, believe that they have imperfections in their appearance and spend time each day on maintaining or modifying their appearance. However, young people with body dysmorphic disorder have persistent, intrusive, unwanted thoughts about perceived defect(s) in their appearance for hours every day that cause them great distress or impact their daily functioning. At some point, they perform excessive, repetitive behaviours in response to these negative thoughts, such as: checking their appearance in mirrors, comparing their appearance to others, seeking reassurance about their appearance, grooming themselves, trying to camouflage their perceived flaws, changing their clothes, exercising or weightlifting, using steroids, undergoing cosmetic surgery, picking their skin and tanning. Because people with body dysmorphic disorder tend to avoid social situations, they often have impairments in their social functioning (e.g., relationships, social activities, intimacy, etc.) and in their daily functioning at school.

Body dysmorphic disorder usually starts in adolescence and is equally as common in girls and boys. The disorder is usually long-lasting if it isn’t treated. Young people with body dysmorphic disorder commonly experience major depressive disorder. Alarmingly, young people with body dysmorphic disorder have high rates of suicidal ideation and suicide attempts and thus are at a high risk of dying by suicide. Young people with body dysmorphic disorder may also have other mental health concerns, such as obsessive-compulsive disorder and social anxiety disorder.

Trichotillomania disorder (Hair-pulling disorder)

It is common for young people to twist, bite, suck or pull out their hair. However, young people with trichotillomania disorder repeatedly pull out their hair causing hair loss to occur and try to reduce or stop their hair pulling. Young people with trichotillomania may pull hair from any area of the body and the sites from which they pull out hair may change over time. Young people with trichotillomania disorder feel distressed (ashamed, embarrassed or as if they have no control) or their hair pulling may negatively impact their daily functioning, often as a result of avoiding engaging in activities such as school, recreational activities and social events. Sometimes the hair pulling is triggered by feelings (such as tension, anxiety, boredom). Sometimes the hair pulling involves rituals in the examination and selection of the hair to be picked, in the technique used to pull out the hair or in examining or handling the hair after it is picked.

Trichotillomania disorder usually starts in adolescence. The symptoms of trichotillomania disorder may wax and wane, but the disorder is usually long-lasting if it isn’t treated. Young people with trichotillomania disorder often have an additional mental health concern, such as obsessive-compulsive disorder, excoriation (skin-picking) disorder or major depressive disorder.

Excoriation disorder (Skin-picking disorder)

It is normal for young people to pick, rub, squeeze or bite their skin. However, young people with excoriation disorder repeatedly pick their skin causing skin lesions to occur and try to reduce or stop their skin picking. Young people with excoriation disorder feel distressed (ashamed, embarrassed or as if they have no control) or their skin picking may negatively impact their daily functioning, often as a result of avoiding engaging in activities such as school, recreational activities and social events. Sometimes the skin picking is triggered by feelings (such as tension, anxiety, boredom). Sometimes the skin picking involves rituals in examining or handling the skin before and after it is picked.

Excoriation disorder usually starts in adolescence and it is considerably more common in girls. The symptoms of excoriation disorder may wax and wane, but the disorder is usually long-lasting if it isn’t treated. Young people with excoriation disorder often have an additional mental health concern, such as obsessive-compulsive disorder, trichotillomania (hair-pulling) disorder or major depressive disorder.

Assessment of obsessive-compulsive disorder and related disorders

During your first session we meet with you and your child to conduct a clinical interview to identify your child’s underlying emotional concerns. Depending on your child’s emotional concerns and age, we may have you, your child, and/or your child’s teacher complete a questionnaire to identify your child’s level of obsessional thoughts and compulsive behaviours before commencing treatment. Finally, we develop a personalised, evidence-based treatment plan to help your child and your family.

Treatment of obsessive-compulsive disorder and related disorders

The aim of our treatment is to reduce your child’s obsessions, compulsions, preoccupations and repetitive behaviours and to overcome the negative impact those thoughts and behaviours are having on your child’s daily functioning. We accomplish this by helping you to understand your child’s thoughts, feelings, needs and behaviours, and by providing your child and family with strategies and skills that challenge your child’s thoughts and behaviours.

We use evidence-based, cognitive behavioural therapy (with an emphasis on Exposure therapy) to treat obsessions, compulsions, preoccupations and repetitive behaviours. We tailor your child’s treatment plan to meet his/her individual needs. We often use a range of cognitive behavioural therapy techniques, including:

Thought-challenging

Emotion regulation training

Problem skills training

Exposure

We may also use the following evidence-based therapy techniques:

Mindfulness/relaxation

Resilience group programs

For more detailed information on what to expect in your sessions with us, please visit our Appointments page.

If you would like help in understanding and managing your child’s obsessive compulsive disorder or other related disorder, please contact us to schedule an appointment.